Clinical Endoscopy

Correlation of Magnifying Endoscopy with Histology in the Gastric Mucosal Elevated Lesions: Jae Young Jang, M.D., In Seop Jung, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D. and So Young Jin, M.D.*; Korean J Gastrointest Endosc 2003;26(2):61-67. Published online February 28, 2003

Abstract PDF: Background
/Aims: This is the study to clarify the relation between the mucosal patterns by magnifying endoscopy and the histologic findings in the gastric mucosal elevated lesions. Methods: The objectives were 51 lesions from 48 patients with gastric mucosal elevated lesions. Gastric mucosal elevated lesions have been magnified up to 80 times by using the magnifying endoscope and were obtained tissue. Magnifying mucosal patterns were classified into 6 types (dot, sulciolar, reticular, irregular, destructive and abnormal vessel pattern) and two group (Group A: dot, sulciolar, reticular pattern-preservation of mucosal arrangement, Group B: irregular, destructive, abnormal vessel pattern-destruction of mucosal arrangement). And then we compared the relation between the mucosal patterns and the histologic findings in the gastric mucosal elevated lesions. Results: In magnifying mucosal patterns, dot, sulciolar, reticular, irregular, destructive, and abnormal vessel pattern were 8, 5, 15, 4, 12, 7, respectively. There was significant difference in the rate of severe dysplasia or carcinoma between two groups (Group A: 0% (0/28), Group B: 70% (16/23) (p＜0.05)). The score of intestinal metaplasia and atrophy in group A were less than that of group B (p＜0.05). Conclusions: Irregularity, destruction and abnormal vessel formation of gastric mucosal pattern by magnifying endoscope may be suspected the histologic malignancy in the gastric mucosal elevated lesions. (Korean J Gastrointest Endosc 2003;26:61⁣67)

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Histological Comparison of Endoscopic Forceps Biopsy with Endoscopic Resection in Gastric Mucosal Elevated Lesion: Jun Young Hwang, M.D., Kyung Sik Park, M.D., Jae Seok Hwang, M.D., Sung Hoon Ahn, M.D. and Soong Kook Park, M.D.; Korean J Gastrointest Endosc 2003;26(2):68-72. Published online February 28, 2003

Abstract PDF: Background
/Aims: The correct histological diagnosis of gastric adenoma is important, because it has been reported to be precancerous lesion and associated with focal gastric carcinoma. However, there is some discrepancy between the histology of the forceps biopsy and that of the endoscopic resection. In this study, we compared the histologic findings of gastric mucosal elevated lesion between the specimens of forceps biopsy and endoscopic resection. Methods: We reviewed retrospectively 137 cases of gastric mucosal elevated lesion which had been removed by the resection such as polypectomy or endoscopic mucosal resection. All patients had undergone forceps biopsy before endoscopic resection. We compared the histologic findings of the specimens by forceps biopsy with those by resection. Results: The histologic fidings were accordant at 101 of the 137 cases (73.7%), and different at 30 cases (21.9%). Among the 86 cases with adenoma in the biopsied specimens, 10 cases (11.6%) were finally diagnosed as gastric cancer in the resected specimens. Conclusions: Because biopsy specimens may not be presentative of the entire lesion, endoscopic resection of gastric mucosal elevated lesion is needed for accurate histologic diagnosis and treatment if adenoma is suspected. (Korean J Gastrointest Endosc 2003;26:68⁣72)

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Endoscopic Photodynamic Diagnosis (PDD) Using Oral 5-aminolevulinic Acid in Gastrointestinal Cancer and Dysplastic Lesions: Young Koog Cheon, M.D., Young Deok Cho, M.D., Jin Oh Kim, M.D., Joo Yong Cho, M.D. Joon Seong Lee, M.D., Yun Soo Kim, M.D., Moon Sung Lee, M.D. and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2003;26(2):73-78. Published online February 28, 2003

Abstract PDF: Background
/Aim: Endoscopic screening for the detection of premalignant high-grade dysplasia remains time consuming and is subject to sampling error. We performed this study to determine the clinical usefulness of laser endoscopic spectra analyzer (LESA-7) in gastrointestinal cancer and dysplastic lesions. Methods: Seventeen patients with histologically proven carcinoma or adenoma with or without high-grade dysplasia were treated with oral administration of 5-ALA (20 mg/kg). PDD was performed 4 hours later. The fluorescence was excited by a helium-neon laser with emission at 637 nm. The generated fluorescence light was collected and fed into a multi-channel analyzer and the full spectrum was displayed in real time (LESA-7). Results: In most of malignant tumors, a clear protoporphyrin IX-related dual-peaked fluorescence signal at about 635 and 700 nm was identified in the fluorescence spectra. However, it was not fully identified in bile duct cancers. In PDD of post-EMR in order to detect residual lesions (gastric flat adenoma 1, early gastric cancer 2), a dual spectra was not identified. Conclusion: PDD with 5-ALA might be useful for the detection of dysplasia and carcinoma in the gastrointestinal tract. (Korean J Gastrointest Endosc 2003;26:73⁣78)

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The Diagnostic Value of Polymerase Chain Reaction in Intestinal Tuberculosis: Tae Kyu Lee, M.D., Young Hwan Kim, M.D., U Im Chang, M.D., Eun Jung Jun, M.D.,; Korean J Gastrointest Endosc 2003;26(2):79-83. Published online February 28, 2003

Abstract PDF: Background
/Aims: It is quite difficult to differentiate intestinal tuberculosis from Crohn's disease because of the similarities of their clinical and pathological features and low detection rate of acid fast bacilli. The diagnostic value of PCR has been studied in pulmonary tuberculosis, tuberculous pleuritis and meningitis, but few reports were made in cases of intestinal tuberculosis. The aim of this study is to evaluate the diagnostic value of PCR in intestinal tuberculosis. Methods: The subjects, a total of 70 cases are composed of clinically diagnosed intestinal tuberculosis, Crohn's disease and intestinal Behcet's disease. We performed PCR with paraffin-embedded intestinal tissue to detect the DNA of Mycobacterium Tuberculosis and the data was analyzed. Results: The positive rate of PCR for Mycobacterium Tuberculosis was 9.8% (4/41) in intestinal tuberculosis, 0% (0/29) in Crohn's disease, and 0% (0/3) in intestinal Behcet's disease. The granulomas were not found in 50% (2/4) of the PCR positive intestinal tuberculosis cases. Conclusions: We were not able to find evidences to prove the excellent value of PCR assay in making differential diagnosis of intestinal tuberculosis from other granulomatous diseases. But it might be helpful in detecting cases of intestinal tuberculosis which were not pathologically or microbiologically confirmed. (Korean J Gastrointest Endosc 2003;26:79⁣83)

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Endoscopically Removed Granular Cell Tumor of the Esophagus -A Case Report and Review of Korean Literature-: Jong Ha, M.D., Ok Jae Lee, M.D., Hwal Suk Cho, M.D., Tae Sik Jung, M.D., Ji Hyang Yoon, M.D., Eun Jung Lee, M.D., Hyun Ju Min, M.D., Tae Hyo Kim, M.D., Woon Tae Jung, M.D. and Joong Hyun Cho, M.D.; Korean J Gastrointest Endosc 2003;26(2):84-89. Published online February 28, 2003

Abstract PDF: Granular cell tumor is a benign tumor, commonly found in the skin, tongue, and breast but rarely in the esophagus. A 44-year-old man was referred from the private clinic because of an esophageal lesion found on endoscopy. Esophagoscopy revealed a white-yellowish polypoid lesion covered with normal looking mucosa in the upper esophagus. It was movable within the wall by pushing with forceps. Endoscopic polypectomy after ligation with elastic "O" band was performed without complication. Histologic diagnosis of granular cell tumor was made. It was stained strongly positive for S-100 protein. Another 20 cases of esophageal granular cell tumors reported in Korean literature were reviewed. (Korean J Gastrointest Endosc 2003; 26:84⁣89)

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A Case of Malignant B-Cell Lymphoma Involving the Stomach in a Patient with Neurofibromatosis Type 1: Dok Yong Lee, M.D., Jun Pyo Chung, M.D., Sang Won Ji, M.D., Jung Hwan Kim, M.D., Jong Kwan Park, M.D., Se Joon Lee, M.D., Byoung Soo Moon, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Eun Ah Shin, M.D.*; Korean J Gastrointest Endosc 2003;26(2):90-93. Published online February 28, 2003

Abstract PDF: Neurofibromatosis type 1, an autosomal dominant disorder, is clinically characterized by the presence of cafe-au-lait spots and cutaneous neurofibromas. Malignancy is a frequently cited and feared complication of neurofibromatosis. Neurofibromatosis has been reported to be associated with some CNS tumors, neurofibrosarcoma, pheochromocytoma, and nonlymphocytic leukemia. Also malignant lymphoma may develop in patients with neurofibromatosis. In Korea, only a case of lung cancer and a case of pheochromocytoma have been reported to develop in patients with neurofibromatosis type 1. Recently, we experienced a case of malignant lymphoma involving the stomach in a 70-year-old woman with neurofibromatosis type 1. An esophagogastroduodenoscopy revealed a 5 cm sized ulcerofungating mass on the greater curvature of the upper body. Histologic diagnosis of the biopsied specimen was B-cell diffuse small and large cell lymphoma. This case illustrates that malignant lymphoma should be included in the differential diagnosis of gastric tumors in patients with neurofibromatosis type 1. (Korean J Gastrointest Endosc 2003;26:90⁣93)

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A Case of Psoas Muscle Abscess in Crohn's Disease: Jin Hee Kim, M.D., Sae Kyung Jang, M.D., Ji Yong Ahn, M.D., Bong Ki Cha, M.D., Dae Won Kim, M.D., Sung Moon Jung, M.D., Yo Han Hong, M.D., Hyung Jun Kim, M.D., Jae Hyuk Do, M.D., Sill Moo Park, M.D. and Sung Il Park, M.D.*; Korean J Gastrointest Endosc 2003;26(2):94-98. Published online February 28, 2003

Abstract PDF: Psoas abscess, complicating Crohn's disease, is a rare condition. Typical symptoms and signs are fever, abdominal tenderness and limb pain. Our patient had fever and abdominal tenderness. The diagnosis is made by abdominopelvic CT scan. Medical therapy with antibiotics, surgical resection of the affected bowel segment with end to end anastomosis and surgical drainage of focus are treatment of choice. We have experienced one case of psoas abscess with Crohn's disease in 28-year-old male patient. He visited our hospital due to diarrhea and lower abdominal pain. The colonoscopy revealed active stage of Crohn's disease. Then he has taken methyl prednisolone and mesalazine. During the hospitalization, we detected anal fistula and psoas abscess on abdominal CT. He was managed with antibiotics and surgical drainage after colectomy. We present the case with brief review of the articles. (Korean J Gastrointest Endosc 2003;26:94⁣98)

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A Case of Colonic Giant Lipoma Removed by Endoscopic Resection: Bo Young Lee, M.D., Seung Won Jeong, M.D., Soon Hyo Kwon, M.D., Jae Young Jang, M.D., In Sub Jung, M.D., Chang Bum Ryu, M.D., Su Jin Hong, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sun; Korean J Gastrointest Endosc 2003;26(2):99-102. Published online February 28, 2003

Abstract PDF: Colonic lipomas represent mesenchymal origin tumors that are second most common benign colonic tumor after hyperplastic polyps and adenomatous polyps. The patho- genesis of them is not clear. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation, and autopsy. According to the size and the location of lipoma, it may cause intestinal obstruction, perforation, intussusception, and life-threatening bleeding. There have been many reports of small colonic lipomas removed by endoscopic resection. Giant lipoma which is greater than 2 cm in size has been associated with higher risk of perforation, thus it has been removed by surgery until now. We report a case of colonic giant lipoma inducing intussusception which could be removed by endoscopic resection. (Korean J Gastrointest Endosc 2003;26: 99⁣102)

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A Case of Colonic Muco-Submucosal Elongated Polyp: Hyun Sung Lee, M.D., Bong Ki Choi, M.D., Woo Seon Seo, M.D., Min Ki Kim, M.D., Jae Kyeoung Lee, M.D., Sung Yeun Yang, M.D., Eun Taek Park, M.D., Yun Sik Jang, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Jung Myung Chung, M.D. and Hye Kyoung Yoon, M.; Korean J Gastrointest Endosc 2003;26(2):103-105. Published online February 28, 2003

Abstract PDF: Colonic muco-submucosal elongated polyp (CMSEP) is a rare disease which has been firstly reported by Matake. Only 21 cases have been reported since 1994. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion for a long period. The occurrence sites were distributed throughout the colon, excluding the rectum. CMSEP is coverd with normal mucosa and consisted of edematous, loose, fibrous, connective tissue and dense, fibrous submucosal layer, often dilatation of blood vessels and lymphatics. We present a case of CMSEP diagnosed by a colonoscopic polypectomy. (Korean J Gastrointest Endosc 2003;26:103⁣105)

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Endoscopic Hemoclipping in a Terminal Ileal Dieulafoy's Lesion: Man Jo Kim, M.D., Jung Sup Eum, M.D., Hae Dong Park, M.D., Soo Hyun Kim, M.D., Sung Min Kim, M.D., Mi Ae Jo, M.D., Dong Ju Song, M.D., Se Lim Choi, M.D., Hee Seung Park, M.D. and Seong Ho Choi, M.D.; Korean J Gastrointest Endosc 2003;26(2):106-109. Published online February 28, 2003

Abstract PDF: Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping. (Korean J Gastrointest Endosc 2003;26:106⁣109)

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Concurrent Yellow-to-white and Black Extrahepatic Bile Duct Stones: Jimin Han, M.D., Seung-Il Pyo, M.D., Sung Koo Lee, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Myung-Hwan Kim, M.D. and Young Il Min, M.D.; Korean J Gastrointest Endosc 2003;26(2):110-113. Published online February 28, 2003

Abstract PDF: Extrahepatic bile duct stones are largely classified into primary and secondary stones. Most extrahepatic bile duct stones are known to migrate from the gallbladder, and thus named secondary stones. Primary stones are formed de novo in the extrahepatic bile duct and are rare. We present an interesting case of a 61 year-old man with obstructive jaundice and biliary sepsis in whom a black extrahepatic bile duct stone and a yellow-to white extrahepatic bile duct stone had been removed during single session of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. (Korean J Gastrointest Endosc 2003;26:110⁣113)

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Three Cases of Gallstone Ileus: Hyun Soon Song, M.D., Myung Hwan Kim, M.D., Hyun Jun Kim, M.D., Dae Kyoum Kim, M.D., Kwi Sook Choi, M.D., Kyang Min Park, M.D., Eun Hee Ko, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Sung Gu Lee, M.D. and Young Il Min, M.D.; Korean J Gastrointest Endosc 2003;26(2):114-118. Published online February 28, 2003

Abstract PDF: Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Gallstone ileus is frequently proceeded by an episode of acute cholecystitis. The resulting inflammation and adhesions facilitate the erosion of the offending gallstone through the gallbladder wall forming a cholecystoenteric fistula and allowing the passage of the gallstone. Fifty five-year-old, 71-year-old, and 74-year-old female patients were admitted to the Asan Medical Center for nausea, vomiting, and nonspecific abdominal pain. Erect abdominal plain film revealed several moderately dilated loops of small bowel with air fluid levels. Computed tomography showed the classic triad of findings of gallstone ileus. Dilated loops of small bowel, air in the biliary tree and an ectopic stone in the ileum were demonstrated. These impacted stones were removed by surgical intervention. (Korean J Gastrointest Endosc 2003;26:114⁣118)

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